MADISON, Wis. — As MAGA House Republicans continue to threaten to shut down the government in pursuit of their extreme agenda, Wisconsin health centers relying on federal funding to provide care are bracing for impact. Without continued funding, it will be more difficult for community health centers, which primarily serve low-income and uninsured Wisconsinites, to keep up with the demand for care, forcing providers to turn patients away at the door.
As the budget stalemate in Washington drags on and the threat of a government shutdown looms, there is an unexpected casualty: health centers in Wisconsin and around the nation that primarily serve low-income residents.
Community health centers, also called federally qualified health centers, are safety net clinics that provide care regardless of an individual’s ability to pay. In addition to payments from private insurance and Medicaid, they also receive support from the federal government.
But that federal funding is in danger of running out on Saturday if Congress doesn’t take action. There are bills in both chambers to extend — and even expand — resources for centers but they are being held up by numerous issues bogging down Congress.
Madison’s community health center network, Access Community Health, has been a mainstay in the area, serving around 30,000 patients last year at its three clinics in Madison, as well as dental clinics in Sun Prairie and Dodgeville. The overwhelming majority of the patients are within 200% of the federal poverty level, which for a family of four comes out to $60,000 per year.
Ken Loving, the chief executive officer for Access, said the federal funding quagmire will create uncertainty for his clinics. And much of the federal funding is designed to help subsidize care for the uninsured, who make up about 20% of Access’ patients.
“It’s unsettling as an organization because you’re trying to plan for the future and rely on federal funding,” Loving said. “And it’s not like our funding would stop. But it causes some uncertainty for us. And I think when our patients hear about this — we’re trying to build trust, and we’re going to hear about things like this. It just causes concern and anxiety a lot of times.”
Conservative House Republicans have thwarted efforts by House Speaker Kevin McCarthy, R-Calif., to move forward with plans to avert a government shutdown. The House rejected a Senate spending bill on Wednesday, causing hopes of reaching a spending deal to dim.
Being at the mercy of a dysfunctional Congress is not a new feeling for health centers. But this standoff is doubly threatening.
The appropriations bills include grant funding, which is allocated by Congress every year.
But there is also separate mandatory funding, appropriated every three years, which accounts for the bulk of the federal funding clinics receive. That is also set to lapse at the end of September.
“They’re trying to plan their budgets for the next year,” said Richelle Andrae, government relations specialist for the Wisconsin Primary Health Care Association. “What can they count on? How can they address the rising cost of providing care to their patients that need them when they don’t know what federal funding will be available?”
Funding for other core programs that health centers rely on is also up in the air. That includes the National Health Service Corps, which provides scholarships and student loan repayment for practitioners who work in underserved communities. There are roughly 200 NHSC members at Wisconsin community health centers.
Much of the funding for the centers comes from Medicaid or private insurance, meaning that facilities won’t close their doors, even if a government shutdown occurs.
But serving people regardless of their health insurance status is a core part of the values that attracted Elizabeth Zeidler Schreiter when she joined Access’ behavioral health team 15 years ago. She is now the system’s chief behavioral health officer.
At about the same time Zeidler Schreiter came aboard, the system was embracing a model that was, back then, fairly novel.
Instead of siloing off behavioral and physical health, Access moved to integrate the two areas. If a patient came in to meet with a primary care physician, they could be connected with mental health treatment that same day.
Stressors ranging from housing and food insecurity to histories of trauma are routine. And, like other providers, Access has witnessed a significant spike in demand for mental health services amid the COVID-19 pandemic.
There was the woman, for instance, whose mother died during the pandemic. Her first thought was to reach out to Access and get connected with telemedicine services, Zeitler Schreiter said, something she found poignant.
“Community health centers have their finger on the pulse of community needs,” Zeidler Schreiter said. “And we know that there are unmet needs in our community. And so trying to build out additional support and resources to help people get the help that they need is really important.”
It is routine for the community centers to see patients who oscillate from lacking insurance to having BadgerCare Plus, the state program covering low-income individuals who might not qualify for Medicaid, or private insurance and, sometimes, who then go back to being uninsured.
But the possible funding crunch comes at a time when thousands of residents are losing BadgerCare coverage after pandemic-era flexibilities ended earlier this year.
For the first time since COVID-19 began, the Department of Health Services has had to determine whether people are eligible for Medicaid. Since June, over 106,000 people have been removed from the BadgerCare Plus rolls. Health care experts have worried that many of them were kicked off for procedural reasons, not because they are actually ineligible for coverage.
That means the uncertain federal funding landscape — and the limits it places on expanding care for the uninsured — is coming at a bad time. Access Community Health already cannot meet the demand, particularly in its dental clinic, Loving said.
“That just makes it harder when we have additional people in our practice that become uninsured,” he said.
Presently, proposals in both chambers of Congress would actually increase the amount of resources that flow to community health centers.
U.S. Sen. Bernie Sanders, the Vermont independent who spoke Friday at Cap Times Idea Fest in Madison, and fellow Sen. Roger Marshall, R-Kan., have proposed a $2 billion per year increase nationally in funding for community health centers, allowing the facilities to expand hours of operation and implement more robust collaborations with schools.
That bill made it out of a Senate committee last week and a separate funding increase also has bipartisan support in the U.S. House. But with budget negotiators at loggerheads, it is unclear what in those measures might become law.
It is common for politicians of all stripes, both at the federal and state level, to endorse community health centers, Wisconsin Primary Health Care Association’s Andrae said.
“All of the congressional staff that we meet have indicated their support for health centers and recognize the important role that health centers play in their local communities,” she said. “So we think that’s very, very positive.”
At the state level, legislators in 2021 secured a funding boost for a program that supports 17 of Wisconsin’s 19 community health centers. It was the first time in a decade that initiative had seen a funding increase.
Community health centers have positioned themselves as a backstop to ensuring people get preventative care for everything from toothaches to diabetes. This ensures they don’t wind up in emergency rooms later on, creating costs for taxpayers or hospitals.
Despite the budget deadlock, that fact isn’t lost on politicians, Loving said.
“We have had great bipartisan support for many, many years,” he said. “And, you know, I think the reason that we’ve had great support is community health centers are a really astute investment for both our federal and state governments to make.”